Crosswalk for Positron Emission Tomography (PET) Imaging Codes G0230 G0030, G0032, G0034, G0036, G0038, G0040, G0042, G0044, G0046

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1 Positron Emission Tomography (PET) CPT to HCPCS Level Crosswalk Changes below from CMS Change Request 3741 Transmittals 518 & 31 published on April 1, 2005; mplementation of CPT codes are effective January 28 th, Claims to be paid by Medicare Contractors no later than April 18 th. For Non Covered PET procedures use G HCPCS codes and obtain and Advanced Beneficiary Notice (ABN). CPT Description CPT /HCPCS Code Myocardial maging, positron emission tomography (PET), metabolic evaluation Myocardial maging, positron emission tomography (PET); single study at rest or stress Myocardial maging, positron emission tomography (PET); multiple studies at rest and /or stress Brain imaging; positron emission tomography (PET); metabolic evaluation Brain imaging; positron emission tomography (PET); perfusion evaluation Tumor maging, positron emission tomography (PET); limited area (eg, chest, head/neck) Tumor maging, positron emission tomography (PET); skull base to mid-thigh Tumor maging, positron emission tomography (PET); whole body Tumor maging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; limited area (eg, chest, head/neck) Tumor maging, positron emission tomography (PET) with concurrently acquired G Series HCPCS Level Code Crosswalk for Positron Emission Tomography (PET) maging Codes G0230 G0030, G0032, G0034, G0036, G0038, G0040, G0042, G0044, G0046 G0031, G0033, G0035, G0037, G0039, G0041, G0043, G0045, G0047 G0229, G0336 imaging for brain perfusion evaluation. G0125, G0210, G0211, G0212, G0213, G0214, G0215, G0216, G0217, G0218, G0220, G0221, G0222, G0223, G0224, G0225, G0226, G0227, G0228, G0253, G0254, G0296 G0125, G0210, G0211, G0212, G0213, G0214, G0215, G0216, G0217, G0218, G0220, G0221, G0222, G0223, G0224, G0225, G0226, G0227, G0228, G0253, G0254, G0296 G0125, G0210, G0211, G0212, G0213, G0214, G0215, G0216, G0217, G0218, G0220, G0221, G0222, G0223, G0224, G0225, G0226, G0227, G0228, G0253, G0254, G0296 with concurrent CT. with concurrent CT. Compliments of SNM Page 1 of 7 PET C & R

2 Positron Emission Tomography (PET) CPT to HCPCS Level Crosswalk computed tomography (CT) for attenuation correction and anatomical localization; skull base to mid-thigh Tumor maging positron emission tomography (PET) with concurrently acquired with concurrent CT. computed tomography (CT) for attenuation correction and anatomical localization; whole body Unlisted Musculoskeletal procedure, diagnostic nuclear medicine G0219 G0252 G0231 G0232 G0233 G0234 NEW G0235 PET imaging whole body; melanoma for noncovered indications PET imaging, full & partial-ring PET scanner only, for initial diagnosis of breast cancer and/or surgical planning for breast cancer (eg, initial staging of axillary lymph nodes) PET, whole body, for reoccurrence of colorectal or colorectal metastases cancer; gamma cameras only PET, whole body, for reoccurrence of lymphoma; gamma cameras only PET, whole body, for reoccurrence of melanoma; gamma cameras only PET, regional or whole body, for solitary pulmonary nodule following CT or for initial staging of pathologically diagnosed nonsmall cell lung cancer; gamma cameras only PET maging, any site, not otherwise specified G0330 PET imaging initial diagnosis cervical G0331 PET imaging restaging ovarian CPT codes and descriptions are copyrighted by the AMA. SNM coding working group consensus opinion recommends CPT to code for PET Bone maging which is determined to be covered on a local level. f indications are considered non covered use G0235. Obtain signed ABN from patient. Continue to use to obtain Medicare denial. Obtain signed ABN from patient. Continue to use to obtain Medicare denial. Obtain signed ABN from patient. There are no CPT codes that directly relate and describe PET with gamma cameras. Use of Unlisted Miscellaneous Diagnostic nuclear medicine CPT code may be the best choice. The SNM Coding & Reimbursement workinggroup will review the CPT code options. This code is to be used for non covered medicare PET services. Providers use to obtain Medicare denial. Obtain signed ABN from patient. Deleted Do NOT Use These Codes. Compliments of SNM Page 2 of 7 PET C & R

3 Positron Emission Tomography (PET) CPT to HCPCS Level Crosswalk 2005 HCPCS Level Code G0030 G0031 G0032 G0033 G0034 G0035 G0036 For All Medicare Contractors CR 3741 Trans 518 Retroactive Effective: January 28, 2005 mplementation: April 18, 2005 MPFS Trans 475 Status HOPPS Trans 514 Non-OPPS Trans 503 HCPCS Level Description PET myocardial perfusion imaging, (following previous PET, G0030-G0047); single study, rest or stress (exercise and/or PET myocardial perfusion imaging, (following previous PET, G0030-G0047); multiple studies, rest or stress (exercise and/or PET myocardial perfusion imaging (following rest SPECT, 78464); single study, rest or stress (exercise and/or PET myocardial perfusion imaging (following rest SPECT, 78464); multiple studies, rest or stress (exercise and/or PET myocardial perfusion imaging, (following stress SPECT, 78465); single study, rest or stress (exercise and/or PET myocardial perfusion imaging, (following stress SPECT, 78465); multiple studies, rest or stress (exercise and/or PET myocardial perfusion imaging, (following coronary angiography, ); single study, rest or stress (exercise and/or Compliments of SNM Page 3 of 7 PET C & R

4 Positron Emission Tomography (PET) CPT to HCPCS Level Crosswalk G0037 G0038 G0039 G0040 G0041 G0042 G0043 G0044 G0045 G0046 G0047 PET myocardial perfusion imaging, (following coronary angiography, ); multiple studies, rest or stress (exercise and/or PET myocardial perfusion imaging, (following stress planar myocardial perfusion, 78460); single study, rest or stress (exercise and/or pharmacological) PET myocardial perfusion imaging, (following stress planar myocardial perfusion, 78460); multiple studies, rest or stress (exercise and/or pharmacological) PET myocardial perfusion imaging, (following stress echocardiogram, 93350); single study, rest or stress (exercise and/or PET myocardial perfusion imaging, (following stress echocardiogram, 93350); multiple studies, rest or stress (exercise and/or PET myocardial perfusion imaging, (following stress nuclear ventriculogram, or 78483); single study, rest or stress (exercise and/or PET myocardial perfusion imaging, (following stress nuclear ventriculogram, or 78483); multiple studies, rest or stress (exercise and/or PET myocardial perfusion imaging, (following rest ECG, 93015); single study, rest or stress (exercise and/or PET myocardial perfusion imaging, (following rest ECG, 93015); multiple studies, rest or stress (exercise and/or PET myocardial perfusion imaging, (following stress ECG, 93015); single study, rest or stress (exercise and/or PET myocardial perfusion imaging, (following rest ECG, 93015); multiple studies, rest or stress (exercise and/or Compliments of SNM Page 4 of 7 PET C & R

5 Positron Emission Tomography (PET) CPT to HCPCS Level Crosswalk G0125 G0210 G0211 G0212 G0213 G0214 G0215 G0216 G0217 G0218 G0219 N No Change E G0220 G0221 G0222 PET imaging regional or whole body; single pulmonary nodule PET imaging whole body; diagnosis; lung cancer, non-small cell (Replaces G0126) PET imaging whole body, initial staging; lung cancer, non-small cell (Replaces G0126) PET imaging whole body, restaging; lung cancer; non-small cell (Replaces G0126) PET imaging whole body; diagnosis; colorectal (Replaces G0163) PET imaging whole body; initial staging; colorectal (Replaces G0163) PET imaging whole body; restaging; colorectal cancer (Replaces G0163) PET imaging whole body; diagnosis; melanoma (Replaces G0165) PET imaging whole body; initial staging; melanoma (Replaces G0165) PET imaging whole body; restaging; melanoma (Replaces G0165) PET imaging whole body; melanoma for non-covered indications PET imaging whole body; diagnosis; lymphoma (Replaces G0164) PET maging whole body; initial staging; lymphoma (Replaces G0164) PET maging whole body; restaging, lymphoma (Replaces G0164) Compliments of SNM Page 5 of 7 PET C & R

6 Positron Emission Tomography (PET) CPT to HCPCS Level Crosswalk G0223 PET imaging whole body or regional; diagnosis; head and neck cancer; excluding thyroid and CNS cancers G0224 G0225 G0226 G0227 G0228 G0229 G0230 G0231 G0232 G0233 G0234 G0235 G0252 N N NEW Code E No Change E PET imaging whole body or regional; initial staging; head and neck cancer; excluding thyroid and CNS cancers PET imaging whole body or regional; restaging; head and neck cancer; excluding thyroid and CNS cancers PET imaging whole body; diagnosis; esophageal cancer PET imaging whole body; initial staging; esophageal cancer PET imaging whole body; restaging; esophageal cancer PET imaging; metabolic brain imaging for pre-surgical evaluation of refractory seizures PET imaging; metabolic assessment for myocardial viability following inconclusive SPECT study PET, whole body, for reoccurrence of colorectal or colorectal metastases cancer; gamma cameras only PET, whole body, for reoccurrence of lymphoma; gamma cameras only PET, whole body, for reoccurrence of melanoma; gamma cameras only PET, regional or whole body, for solitary pulmonary nodule following CT or for initial staging of pathologically diagnosed nonsmall cell lung cancer; gamma cameras only PET maging, any site, not otherwise specified PET imaging, full & partial-ring PET scanner only, for initial diagnosis of breast cancer and/or surgical planning for breast cancer (eg, initial staging of axillary lymph nodes) Compliments of SNM Page 6 of 7 PET C & R

7 Positron Emission Tomography (PET) CPT to HCPCS Level Crosswalk G0253 PET imaging for breast cancer, full and partial-ring PET scanners only, staging/restaging of local regional recurrence or distant metastases (ie, staging/restaging after or prior to course of treatment G0254 G0296 G0330 G0331 Deleted Deleted PET maging for breast cancer, full & partial-ring PET scanners only, evaluation of response to treatment, performed during course of treat PET imaging, full & partial-ring PET scanner only, for restaging of previously treated thyroid cancer of follicular cell origin following negative -131 whole body scan PET imaging, initial diagnosis dx cervical Short description only available from CMS PET image restage ovarian ca Short description only available from CMS PET imaging brain Alzheimer s (short) PET imaging, brain imaging for the differential diagnosis of Alzheimer's disease with aberrant features vs. fronto-temporal G0336 dementia MPFS = Medicare Physician Fee Schedule Federal Register Vol. 69 No 219 Monday November 15, 2004 p Status ndicator. This indicator shows whether the CPT/HCPCS code is included in the physician fee schedule and whether it is separately payable if the service is covered. = Not valid for Medicare purposes, Medicare uses another code for the reporting of and the payment for these services. (Code not subject to a 90 day grace period.) N = Noncovered service. These codes are noncovered services. Medicare payment may not be made for these codes. f RVUs are shown, they are not used for Medicare payment. HOPPS = Hospital Outpatient Prospective Payment System Federal Register Vol. 69 No 219 Monday November 15, 2004 p Payment Status ndicator. This indicator shows whether the CPT/HCPCS code is included in the Hospital Outpatient Prospective Payment Schedule and whether it is separately payable if the service is covered. E = Noncovered item or service. These codes are noncovered services. Medicare payment may not be made for these codes. Not Paid Under OPPS. Compliments of SNM Page 7 of 7 PET C & R

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